No-shows to primary care appointments: Subsequent acute care utilization among diabetic patients

Lynn A. Nuti, Mark Lawley, Ayten Turkcan, Zhiyi Tian, Lingsong Zhang, Karen Chang, Deanna Willis, Laura P. Sands

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Patients who no-show to primary care appointments interrupt clinicians efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics. Methods. A prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6months (182days) following the patients last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model. Results: The six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d.=0.83) for no-shows and 0.14 (s.d.=0.63) for those who attended (p<0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR=1.60, CI=1.17-2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d.=1.48) for no-shows and 0.38 (s.d.=1.05) for those who attended (p<0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization. Conclusions: No-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.

Original languageEnglish
Article number304
JournalBMC Health Services Research
Volume12
Issue number1
DOIs
StatePublished - 2012

Fingerprint

Primary Health Care
Appointments and Schedules
Hospital Emergency Service
Hospital Departments
Continuity of Patient Care
Ambulatory Care Facilities
Insurance
Proportional Hazards Models
Hospitalization
Cohort Studies
Prospective Studies

Keywords

  • Diabetes
  • Emergency department visits
  • Hospital admissions
  • No-show
  • Outcomes

ASJC Scopus subject areas

  • Health Policy

Cite this

Nuti, L. A., Lawley, M., Turkcan, A., Tian, Z., Zhang, L., Chang, K., ... Sands, L. P. (2012). No-shows to primary care appointments: Subsequent acute care utilization among diabetic patients. BMC Health Services Research, 12(1), [304]. https://doi.org/10.1186/1472-6963-12-304

No-shows to primary care appointments : Subsequent acute care utilization among diabetic patients. / Nuti, Lynn A.; Lawley, Mark; Turkcan, Ayten; Tian, Zhiyi; Zhang, Lingsong; Chang, Karen; Willis, Deanna; Sands, Laura P.

In: BMC Health Services Research, Vol. 12, No. 1, 304, 2012.

Research output: Contribution to journalArticle

Nuti, Lynn A. ; Lawley, Mark ; Turkcan, Ayten ; Tian, Zhiyi ; Zhang, Lingsong ; Chang, Karen ; Willis, Deanna ; Sands, Laura P. / No-shows to primary care appointments : Subsequent acute care utilization among diabetic patients. In: BMC Health Services Research. 2012 ; Vol. 12, No. 1.
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AU - Nuti, Lynn A.

AU - Lawley, Mark

AU - Turkcan, Ayten

AU - Tian, Zhiyi

AU - Zhang, Lingsong

AU - Chang, Karen

AU - Willis, Deanna

AU - Sands, Laura P.

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N2 - Background: Patients who no-show to primary care appointments interrupt clinicians efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics. Methods. A prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6months (182days) following the patients last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model. Results: The six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d.=0.83) for no-shows and 0.14 (s.d.=0.63) for those who attended (p<0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR=1.60, CI=1.17-2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d.=1.48) for no-shows and 0.38 (s.d.=1.05) for those who attended (p<0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization. Conclusions: No-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.

AB - Background: Patients who no-show to primary care appointments interrupt clinicians efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics. Methods. A prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6months (182days) following the patients last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model. Results: The six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d.=0.83) for no-shows and 0.14 (s.d.=0.63) for those who attended (p<0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR=1.60, CI=1.17-2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d.=1.48) for no-shows and 0.38 (s.d.=1.05) for those who attended (p<0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization. Conclusions: No-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.

KW - Diabetes

KW - Emergency department visits

KW - Hospital admissions

KW - No-show

KW - Outcomes

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